A 4.4.1.

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Aguttara Nikya 4, Catukka Nipta 4, Catuttha Pasaka 1, Indriya Vagga 7

(Dve) Roga Sutta

The Discourse on (the Two Kinds of) Diseases | A 4.157/2:142 f
Also Pabbajitassa Roga Sutta The Discourse on the Diseases of a Renunciant
Theme: We should be both physically and mentally happy
Translated & annotated by Piya Tan 2013

1 Body and mind

1.1 TWO KINDS OF SUFFERING. The Sallatthena Sutta (S 36.6), speaks of the two kinds of pain
physical and mental and how to deal with them. When an untutored ordinary person feels pain, he suffers twice. Firstly, his body feels the pain, and then he react unhappily to this, so that his mind suffers,
too.
When he feels a painful feeling, he sorrows, grieves, laments, beats his breast, becomes confused,
and so he suffers twice: physically and mentally. As a result, the latent tendency of aversion is reinforced.
When he feels a pleasant feeling, he delights in it, and so the latent tendency of lust is reinforced. And
when he feels a neutral feeling, he does not know it, and so the latent tendency of ignorance is reinforced
in him.
Unable to free himself of these sufferings, both the bodily and the mental, he turns to sensual pleasure
(sex, drunkenness, quarrels, violence, etc) as a means of escape, because, bhikshus, the untutored ordinary person knows no other escape than through sensual pleasure. And so his suffering grows.1
1.2 ELEMENTS OF THE BODY
1.2.1 The elements, internal and external. We consist of body and mind.2 The body is made up the
4 primary elements: earth, water, fire and wind.3 Earth is the solid aspects of our body, such as head
hair, body hair, nails, teeth and skin.4 Water is the fluid aspects, which form most of our body, that is,
bile, phlegm, pus, blood, sweat, fat;5 tears, skin-grease [tallow], saliva, snot, oil of the joints, and urine.6
Fire is the temperature (heat and cold), digestive process and decay of the body.7 And wind includes our
breath, gases or winds in the body, persitalsis and any kind of bodily movement.8
1.2.2 Balancing the elements. These 4 internal elementsearth, water, fire and windthat constitute our body are the same as the external 4 elements all around us, including space, the fifth element.9
Both kinds of elements are impermanent, changing, becoming otherwise; in other words, they are
unstable. When any of the external elements predominate, that is, there is some kind of external
unbalance, some kind of natural disaster would strike.
Unbalance in the earth element appears in the form of sinkholes, deserts and earthquakes. Unbalance
in the water element is seen as torrential rains and floods. Fire in nature destroys vast stretches of greenery and life, and also property. The wind in nature can either cause windstorms, dust-storms and sandstorms, or cause air pollution if the atmosphere is stagnant.
In a very meaningful set of reflections, the Buddha teaches us to be mindful of how we are intimately
interconnected with nature as our full ecology, that is, as healthy living space and wholesome mental

S 36.6.8c/4:208 = SD 5.5. Comy: The escape is mental concentration, the path and the fruit, but he does not
know this, knowing only sensual pleasure (SA 3:77). See also Vedan, SD 17.3 (7.3).
2
See The unconscious, SD 17.8b (2.2.3 & Fig).
3
On the 4 elements or 5 elements (incl space), see Mah Rhulovda S (M 61,8-12/1:421-423) & SD 3.11 (4)
for refs.
4
These form the skin pentad (taca,pacaka): see Mah Rhulovda S (M 61,8/1:421), SD 3.11.
5
These 6 items form the fat sestet (meda,chakka): see Mah Rhulovda S (M 61,9/1:421), SD 3.11.
6
These 6 form the urine sestad (mutta,chakka): see Mah Rhulovda S (M 61,9/1:421), SD 3.11.
7
See Mah Rhulovda S (M 61,10/1:421), SD 3.11.
8
See Mah Rhulovda S (M 61,11/1:421), SD 3.11. On how winds cause pains, see Dhnajni S (M 97.2829/2:193), SD 4.9. For a summary Table, see Rpa, SD 17.2a (Table 6).
9
On the 5 elements, see Mah Rhulovda S (M 61,8-12/1:421-423), SD 3.11.

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being.10 We are first taught to identify the element in various parts of our own body (the internal element).
Then we consider that such internal elements are the same as their external state, that is, The earth element inside me and the earth all around me is the same earth element.
Both the internal elements and the external elements are impermanent. They are both simply element, and that should be seen, according to reality, with right wisdom thus: This is not mine, this I am
not, this is not my self. This point is vital: although we identity the elements, we do not identify with
any of them: I am not that.11
1.3 CONSTITUENTS OF THE MIND. What we generally understand as the mind is made up of feeling, perception, volition, contact and attention (vedan, sa, cetan, phassa, manasikra, S 12.2).12 In
other words, our mind is an interactive complex of how we feel (liking and disliking), how we are moved
to do things (whether through desire, dislike or delusion or through charity, love or wisdom), how we see
the world (how we respond to our sense-experiences) and our ability to hold on to the present moment (or
letting our imagination have the better of us),
Wethat is, our mindscommunicate with the external world, with people and situations, through
our speech and actions, and behind these lurk our thoughts. If we are unmindful, then we would fail to see
the true reality of these external realities, and so form wrong ideas about them. Our world, then is a false
one, which would only give us a false sense of truth, beauty and security. We are not really able to enjoy
our lives because we fail to see the truth, and we are open to more troubles. Hence, discourses like the
Attna Rakkhita Sutta (S 3.5) remind us that it is better to guard ourself internally, that is, to guard our
own body and mind.13

2 Bodily dis-ease and ease

2.1 BODILY PAINS AND ILLNESSES
2.1.1 Typology. Similarly, if our bodily elements are unbalanced, we do not feel well, or might even
be serious ill, ending in death. The Svaka Sutta (S 36.21) mentions the following 8 causes and conditions for pains and illnesses, namely:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

bile disorder (preponderance of the internal earth element);

phlegm disorder (preponderance of the internal water element);
wind disorder (preponderance of the internal wind element);
a combination of the three;
weather changes (temperature, humidity, etc, preponderance of the fire element);
improper care (including lack of hygiene);
assaults or trauma caused by external agencies; and
karmic fruition.
(S 36.21/4:230 f), SD 5.6

2.1.2 Karma as habit. Karma is not a dogmatic system of rewards and punishments, as our karmic
acts would not fruit unless the conditions are right. Furthermore, karma is not fate or determinism,14 as we
are capable of nurturing ourselves and changing, even preventing, the effects of our past karma.15 If our
lives have been predetermined, or everything is willed by some divine being, then we are powerless to

10

On the 5-element reflections, see Mah Rhulovda S (M 61,8-12/1:421-423) & SD 3.11 (4) for refs. See also
Rpa, SD 17.2a (11) Meditating on the elements.
11
On not-that-ness, see Atammayat. SD 19.13.
12
S 12.2,11/2:3 (on name-and-form) = SD 5.15.
13
S 3.5/1:72 f = SD 38.9.
14
Fate-rooted belief entails resorting to luck, magic, rituals and some kind of external way of changing our lives,
when the real roots of our problems are within, ie, in our minds: see Emotional independence, SD 40a.8 (5) Attachment to rituals and vows.
15
On how lovingkindness can prevent negative karma, see Karaja,kya Brahma,jla S (A 10.208) @ SD 2.10
(2) & Love, SD 38.4 (6.3).

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change ourselves, and there is no need of ethics or religion, since whatever we do is already predetermined, or we are only acting out a divine will.
Karma, on the other hand, is our habitual life. Sow an act, reap a habit. Sow a habit, reap a character.
Sow a character, reap a destiny. The principle is something like this: whenever we deliberately act
(whether by thought, word or deed), we are likely to act this way again. For example, if we were to be
angry, we are likely to be angry again, especially when similar conditions were to arise.
Our habit of getting angry then becomes easier: it has become a character. And if this goes on,
without any conscious effort to change ourselves for the better, then we would, in due course, face the
dire consequences of such a character. Our destiny or rebirth would be a state that is characterized by
constant anger, violence and so on.16
2.1.3 Perception of danger. In the Giri-m-nanda Sutta (A 10.60), the Buddha teaches nanda the
perception of danger (dnava,sa), thus:
Here, nanda, a monk who has gone to the forest, or to the foot of a tree, or to an empty
place, reflects thus:
Of much suffering is this body, with many dangers! Various kinds of illnesses arise in the
body, such as17
eye ailment, hearing ailment, nose ailment, tongue ailment, body ailment,
head ailment, ear ailment, mouth ailment, teeth problem, cough,
cold, heat [burning], fever, stomach ailment, faintness [swooning], diarrhoea, colic, cholera,
leprosy, abscess [boils], eczema, tuberculosis, epilepsy;18
ringworm,19 itch, scabs, pustules,20 scabies, jaundice,21 diabetes, piles, boil, fistula,
22
bile disorder,23 phlegm disorder,24 wind disorder,25 a combination of them, a change in the
temperature, improper self-care,26 ailments due to assault [trauma upon oneself caused by
outside agencies],27 ailment due to the results of ones karma,
16

See eg Emotional independence, SD 40a.8 (Appendix) Identifying personality problems.

This section contains one of the oldest references of medicine in Indian social history. See SD 19.16 (2).
18
Those with these 5 diseases are barred from joining the order (V 1:70-73, 93, 2:271, 4:8; VA 995 f; see also Nm
1:17, 47, 2:304; Nc 166).
19
Daddu, Skt dadru, dardru, dadrula, dardura (dardara), dardula, dradula, a skin disease, probably a kind of
leprosy or ringworm.
20
Rakhas, rakhass, nakhas. Comy say that this is an ailment at the place scratched by the nails (nakha) (AA
5:43; NmA 1:61).
21
Lohita,pitta, lit bile in the blood. Jaundice is conjectured by FL Woodward, A:W 5:75.
22
While the first 4 ailments are internal, the rest are external, except for karmic results, which are both. The first 4
of these ailmentsthe 3 peccant (illness-bringing) humours and their combinationare central to yurveda medical aetiology. The first 3 humours (Skt doa) are the tri,doa of yurvedic medicine. They also form a prominent
aspect of the Mahyna medicinal philosophy and healing (Zysk 1998 ch 4). These 8 ailments are mentioned in
Svaka S (S 36.21 = SD 5.6), Samaa-m-acala S 1 (A 4.87.5/2:87), and (Samaa) Sukhumla S (A 5.104/3:131).
In the last sutta, one who is disease-free is said to be one free from these 8 causes (cf Nm 370). In Milinda,paha
(Miln 134 f), Ngasena discusses the 8 causes of suffering in the context of the Buddhas lack of moral vice. All this
attests to the early history of this aetiology.
23
Symptoms of bile disorders (bhagandal) include nervousness and excitement suggesting that one has emotional and neurotic problems.
24
Symptoms of phlegm disorders (pitta,samuhn bdh) include sluggishness and apathy suggesting that one
has depression.
25
Symptoms of wind disorders (vta,samuthn bdh) include hiccup, stitch (brief sharp pain running through
the body) and stomach-ache. Also at Sivaka S (S 36.31.6/4:230) = SD 5.6.
26
Causes of visama,parihraj bdh include sitting or standing too long, and being bitten by a snake.
27
Opammik bdh. It is also translated as assault or external agency, but the Pali forms upakkama, opakkama, opakkamika, and the Sanskrit upakrama (from upa- and KRAM, to stride) have the primary meaning of
attacking suddenly. As such, Zysk thinks it therefore could be equivalent to the gantu, or external, category of
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SD 42.16
cold, heat, hunger, thirst, voiding, urinating.
Thus he dwells contemplating the dangers in this body.

A 4.157/2:142 f (Dve) Roga Sutta

(A 10.60,7/5:110), SD 19.16

This is a form of perception of impermanence whose purpose is to motivate ourselves to assert ourselves
in our meditation practice before such illness overcomes and weakens us.
2.1.3 The Buddhas illnesses. Even the Buddha, on account of his having a physical body, that body
suffers various pains and sickness, such as the following:
he suffers from back-aches
A 9.4/4:359
SD 73.4
he has a fever
S 46.16/5:81
SD 43.1328
his foot is hurt by a fling rock splinter
Miln 1:136
he suffers from dysentery during his last days D 16,2.23/2:99 +4.20/2:126
SD 9
Regarding the Buddhas back-ache, the Sayutta Commentary explains it as arising from non-karmic
causes. that is, present conditions:
Why did it [his back] pain him? The Blessed One, who had devoted himself to the great
exertion for six years [as an ascetic], had a great deal of bodily suffering. Later on, when he was
very old, he had back trouble. That [backache] had no karmic cause (akaraa).
(SA 3:52)
2.1.4 Dealing with pain
2.1.4.1 We have already noted that we experience two kinds of feelings [1.1], the bodily and the mental. Bodily pain means that some physical parts (earth, water, fire or wind elements) [1.2.1] is going
through change right here and now. Some solid, fluid, heat or moving aspects of our body has shifted in
its element, one aspect has been taken over by another. In scientific terms, we would say, some cells are
being destroyed or some body parts are malfunctioning.
2.1.4.2 The (Anicca) Vedan Sutta (S 25.5) gives a very simple teaching regarding feelings: all we
need to do is to regard any kind of feeling, whether pleasant, unpleasant or neutral, arising from any of the
sense-doors, as being impermanent, changing, becoming otherwise. If this is done on a regular basis,
whether with wise faith or with wisdom, the Buddha guarantees that we will be able to attain streamwinning in this life itself, if not certainly at the moment of dying.29
2.1.4.3 The Nakula,pit Sutta (S 22.1) teaches us a step further, bringing us to the reflection of nonself. Firstly, the Sutta declares how both the body (kya) and the mind (citta) can be sick (atura), that is,
when we regard the aggregates (form, feeling, perception, formations and consciousness) in term of a
self.30 However, even the body is sick, we can restrict the pain only to the body without affecting the
mind, by not regarding any of the aggregates in terms of a self. In this way, even though our body is sick,
our mind is not sick.31

3 Mental dis-ease and ease

The Vibhaga Commentary states that: The ordinary person is like one mad (ummattako viya hi
puthujjano) because he, without considering, Is this right or wrong? on account of some kind of cling-

disease causation in Indian medicine. According to the yurvedic medical tradition, gantu causes are generally
violent and traumatic and involve injury to the body [Caraka Sahita Strasthna 20.3; Suruta Sahit Strasthna 1.24 f] (Zysk 1998:30). This suffering may arise from being arrested for crime, being attacked by robbers,
accidents, etc; the Buddhas foot being hurt by a piece of rock due to Devadattas attempted assassination.
28
Gilna S 3 (S 46.16/5:81), SD 43.13. See also Gilna S 1 (S 46.14/5:79 f), SD 43.11 (Mah Kassapas illness),
Gilna S 2 (S 46.15/5:80), SD 43.12.
29
S 25.5/3:227 = SD 17.3(4.5.1). For details, see (Anicca) Cakkhu S (S 25.1), SD 16.7.
30
On how to reflect on the 5 aggregates, see (Anicca) Sha S (S 22.78) @ SD 42.10 (2).
31
S 22.1/3:1-5 = SD 5.4.

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ing, creates some kind of karma out of desire for some kind of existence32 (VbhA 186). In short, the
untutored ordinary person is mad because he acts out of greed, hate and delusion.
According to the Sallatthena Sutta (S 36.6), while the untutored ordinary person, ignorant of the
true nature of feelings, suffers twice [1.1], the wise noble disciple understands the true nature of feelings.
When he feels a painful feelings, he shows no aversion to it, because he knows an escape beyond sensual
pleasures, that is, through mental bliss. When he feels a sensual pleasure, he does not delight in it, because he understands, according to reality, the arising, the passing away, the gratification, the danger and
the escape with regards to feelings. And when he feels a neutral feeling, he understands it according to
reality, because ignorance does not lie latent in him.33

The Discourse on (the Two Kinds of) Diseases

A 4.157/2:142 f

Physical health, mental health

1 Bhikshus, there are these two kinds of diseases [illnesses]. What are the two? [143]
2 Disease of the body and disease of the mind.34
3 Bhikshus, there are to be seen beings who can claim to be physically healthy [disease-free of
body] for a year,
who can claim to be physically healthy for 2 years,
who can claim to be physically healthy for 3 years,
who can claim to be physically healthy for 4 years,
who can claim to be physically healthy for 5 years,
who can claim to be physically healthy for 10 years,
who can claim to be physically healthy for 20 years,
who can claim to be physically healthy for 30 years,
who can claim to be physically healthy for 40 years,
who can claim to be physically healthy for 50 years,
who can claim to be physically healthy for a 100 years.
4 But, bhikshus, not easy it is to find those beings in this world who can claim to be mentally healthy for even a moment except for those (arhats) whose mental influxes are destroyed.35

The 4 diseases of a renunciant

5 Bhikshus, there are these four diseases of the renunciants. What are the four?
6 (1) Here, bhikshus, a monk has great desire, distress, and discontent36 with any kind of robe,
almsfood, lodging or support for the sick and medicinal supply.37
32

So ida yutta ida ayuttan ti avicretv yassa kassaci updnassa vasena ya kici bhava patthetv ya
kici kamma karoti yeva (VbhA 186).
33
S 36.6,9-10/4:209 = SD 5.5.
34
Kyiko ca rogo cetasiko ca rogo.
35
Te bhikkhave satt sudullabh* lokasmi, ye cetasikena rogena muhuttam pi rogya paijnanti aatra
khsavehi. *So Be; Ce E Ke Se dullabh.
36
He is discontent with the 4 supports by way of the 3 kinds of contentment (AA 1:77-80). Comy ad Santuhita
S (A 1.65/1:12) gives these 3 kinds of contentment (santosa): (1) contentment regarding what we gain (yath,lbha,santosa), ie, whatever kind of robe, etc, we obtain; (2) contentment regarding our strength (yath,bala,santosa), ie
from what we obtain, selecting only from what conduces to our health; (3) contentment in regards to what is appropriate (yath,sruppa,santosa), ie keeping what we basically need, and giving away the rest (AA 1:78 f). For the 12

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7 (2) On account of his great desire, distress, and discontent with any kind of robe, almsfood, lodging or support for the sick and medicinal supply,
he has bad wishes, desire for gaining recognition, and gaining wealth, honour and praises.38
8 (3) He rouses, strives, exerts himself in gaining recognition, and gaining wealth, honour and
praises.
9 (4) With cunning he approaches families, with cunning he sits down, with cunning he teaches the
Dharma, with cunning he holds back his excreting and urinating.39
10 Bhikshus, these are the four diseases of the renunciants.

Spiritual training
11 Therefore, bhikshus, you should train yourselves thus:
12 We will not harbour great desire, distress, or discontent with any kind of robe, almsfood, lodging
or support for the sick and medicinal supply;
13 nor will we harbour bad wishes, desires for gaining recognition, and gaining wealth, honour and
praises;
14 nor will we rouse, strive, exert ourselves in gaining recognition, and gaining wealth, honour and
praises.
15 We will endure the touch of cold, heat, hunger, thirst, gadflies, mosquitoes, wind, sun, and creeping things.
16 We will endure abusive and offensive manners of speech.
17 We shall patiently endure painful feelings that arise in our bodies, sharp, piercing, racking, unpleasant, disagreeable, taxing on our breaths [sapping our life itself].40
18 Thus, bhikshus, should you train yourselves.
eva
130304; 130311; 130409; 130504r

kinds of contentment (these 3 4 supports, DA 1:204-207), see Bodhi, The Discourse on the Fruits of Recluseship,
1989: 134-138, repr 2008:130-134.
37
Idha bhikkhave bhikkhu mahiccho hoti vightav asantuho itartara,cvara,piapta,sensana,gilna-p,paccaya,bhesajja,parikkhrena.
38
Ppika iccha paidahati anavaa-p.pailbhya lbha,sakkra,siloka-p,pailbhya.
39
So sakhya kulni upasakamati, sakhya nisdati, sakhya dhamma bhsati, sakhya uccra,passva
sandhreti. Comy says that he is calculative (sakhya) by way of making pretensions (thus they would know me,
iti ma ete jnissantti) before families (for the sake gains, etc) (AA 3:135). He holds back answering natures
call clearly because he is absorbed in worldly intercourse, as he does not want to miss any opportunity for gains, etc,
even at the cost of his own health and wellbeing.
40
Uppannna srrikna vedanna dukkhna tibbna kharna kaukna astna amanpna
pa,harna adhivsaka,jtik bhavissmti.

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